Periodic gastroenterology and hepatology meetings with primary care: reasons for consultation

Abstract

Introduction: care overload, aging of population, and increased chronic diseases lead to increased referrals from primary care, which may sometimes overload the health system. Thus, different interventions have been carried out attempting to improve these aspects.Objectives: to assess the most frequent causes of consultation of general physicians, both in joint consultations and clinical sessions held jointly with specialist consultant in primary care, in the urban and rural setting, and the influence on referrals to first consultations of gastroenterology.Material and methods: a mainly training type of intervention was carried out, consisting of regular meetings in both urban and rural primary care center, to perform joint consultations and clinical sessions on patients and topics related to the specialty of gastroenterology. The intervention period (divided in two subperiods) was compared with a control period.Results: most reasons for consultation were those corresponding to lower gastrointestinal tract, followed by liver disease and upper gastrointestinal tract. Significant differences were only found in distribution of diagnoses between the two centers in joint consultations. There was a relative (percent) decrease in referrals at the global level in both subperiods, only significant in the first (51.45 %), as well as in rural setting (45.24 %).Conclusion: common consultations motifs were similar in urban and rural settings, with some relevance of lower gastrointestinal tract disease. Most of them can be solved at primary care, with the help of consultant specialist. There is impact on referrals to the outpatient first consultations of gastroenterology, mainly in rural setting.

Improving Access to Gastroenterologist Using eConsultation: A Way to Potentially Shorten Wait Times

“…(6) Building capacity within primary care on common referral scenarios can help reduce the number of referrals to subspecialty services, thus increasing time for more urgent consultations and sicker patients. (7)…”

Improvement Strategies for the Challenging Collaboration of General Practitioners and Specialists for Patients with Complex Chronic Conditions: A Scoping Review

“…As part of patient- and disease-related factors, authors specified that highly prevalent health conditions were focused on in the interventions. Authors reported on the respective condition’s burden on healthcare facilities or system resources such as high consultation rates [ 30 31 35 ] or costs [ 36 37 38 39 40 41 ]. Furthermore, projects presented that the health condition of interest is a leading cause of morbidity, hospitalisations and death [ 37 38 39 40 42 43 44 45 46 ].…”

“…two projects were from Australia [ 49 52 53 ], Brazil [ 47 51 ], Spain [ 35 54 ], Switzerland [ 33 34 45 ] and the Netherlands [ 27 55 ].…”

“…• five were from the United States [26, 30, 31, 38-40, 42-44, 50, 51], • four were from Canada [28,29,36,37,48]; • two projects were from Australia [49,52,53], Brazil [47,51], Spain [35,54], Switzerland [33,34,45] and the Netherlands [27,55]. • and one project was from Germany [32], Italy [41] and New Zealand [46], respectively.…”

“…Specific diagnoses chronic kidney disease (CKD) 5 projects [26,27,[37][38][39][40][41] chronic obstructive pulmonary disorder (COPD) 3 projects [33,34,45,50] diabetes type 2 2 projects [49,52,55] combination of asthma and COPD 1 project [47] chronic hepatitis B 1 project [53] chronic heart failure 1 project [42][43][44] coronary artery disease 1 project [51] at least one of the following was present: diabetes, cardiovascular disease, COPD, asthma or cardiovascular risk factors 1 project [28,29] Unspecific patient population (regarding diagnoses) long-term 2 projects [36,46] end of life care 1 project [32] multiple chronic conditions 1 project [30,31] heart diseases 1 project [54] gastroenterology and hepatology 1 project [35] kidney diseases 1 project [48] Furthermore, GPs and primary care staff enhanced their knowledge in daily practice. Mostly, they were encouraged to communicate more and share information with each other and specialists.…”